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AN <br /> fJ< A 9 Uf T C AND ANALYSIS REQUEST <br /> r7 c O c 5 <br /> i GVOU <br /> � 85 <br /> tr,eo rro iEs ir,c ( 3 1 43 <br /> )mpany Name Phone# <br /> G� FAX# Q ❑ <br /> )mpany Address yGyr f}VR Site location li y �j 41 Cl�ar �( ylq`J wCC, EJ = Q Q <br />� C tic? VP—SrSf�Gr�r+t��a G� S rOG��a1.1 r Q[J VIP C] Lia d CC Q ❑ <br />'elect Manag`p�r � } Chent Project to (#} �U-� Z 0b10`3 ❑ x ;, "' + +1131 <br /> 0 a ❑ 0 ? <br /> NAME 1�, Lu p o ❑ LI ❑ ❑ z z Q 0 0 n f • <br /> (NAME) __ S _ _ _ a <br /> fittest that the proper field sampling Sampler Name (Print) Ln O in o ❑ 1J in ❑ U <br /> rcedures were used duringthe colleclion v ❑ ' ❑ C J -' *—' n ? rt s i <br /> Q J ~2 co T N ❑ 13 cO < `L U T O <br /> these samples V 1 V� 1- Q O o [Y ,�j N� a a o N ❑ O Ln Q <br /> Method �] N r a ❑ EA <br /> Matrix Sampling o � o �* "' a a CO W m ❑ a L <br /> Field GTEL Preserved o C c 0 ❑ n ©131 d y © ❑ <br /> Sample Lab w �, ❑ ❑ ❑ li a 1:1 N 3 <br /> O a (� Q N <br /> to (} �- O O N N N K >U T <br /> ID (Lab use only) U rW- 00 W O w wv W W o o c Q to m rn w w t7 s N <br /> 'F Q OCL J F= U ZZ CO W a =a Q W W V T [ri Q Q Q Q ¢ 4 4 } -J Q <br /> yr a to a O X x u: <br /> oi!)O F- III a, 2 2 O FF-- W W W W W W W W W H W U O U <br /> NN"iX. <br /> d <br /> 14�y - - - ) <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS /T <br /> L� <br /> -wily(24 hr) ❑ GTEL Conlacl <br /> epedded(48 hr) ❑ OuotelConlracl 1 <br /> lusiness Days ❑ Confirmation R <br /> tier Z wYck- PO i4 SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> siness Das ❑ <br /> OA 1 OC LEVEL <br /> UE❑ CLF'❑ OrHER FAX❑ Work Order# <br /> Relinquish y sampl k e Time Received by <br /> I <br /> J U S T 0 D`, nehnquish y Date Time Received by <br /> RECORD Relinquished by Date Time Received by <br /> //Labo atory <br /> cu <br /> 3{r 0 <br /> 7191 � Waybill # <br />